Anyone have Spondylitis before Crohn's diagnosis?

[jimmyt1989]

I apologize if this has been discussed previously. I tried the search option, but couldn't find an exact match to my question.

Quick history, vague symptoms for years (joint pain, fatigue, stools match irritable bowel more than Crohns).

Several blips on the radar with CT scans and scopes (endo and colon), but nothing to confirm Crohn's. In fact, CT scan from 2 months ago showed Colitis, but after treatment with antibiotics the colonoscopy was clear 3 weeks ago.

My mom has Crohns and I'm consistent with Crohns on the prometheus test.

I have lots of joint pain. In particular, the feet, heels and low back. The MRI from last Friday, revealed severe degeneration of the disc between L5-S1. Also, milder degeneration between the L3-L4, and L4-L5. There is also chornic endplate changes as well as endplate osteophyte formation.

I'm negative on every known arthritis test.

I am being referred to a neurosurgeon at MUSC, and the gastro at MUSC is treating me for crohns even though she can't make a firm diagnosis without seeing it on a scope or biopsy.

I've read that spondylitis can predate the intestinal inflammation, but I was wondering if anyone else here had experienced something similar.

 

[Clash]

My son's joint pain showed up before his CD issues. Yet he was dxed with CD shortly after CD symptoms started occurring.

He wasn't dxed with his JSpA (juvenile spondyloarthropathy until about 2 years into his CD dx.

There are some joint conditions that have GI issues like analysing spondylitis.

I'm going to tag maya142 as she has a lot of experience in this area.

 

[Maya142]

My younger daughter was diagnosed with AS before she was diagnosed with Crohn's. Have you seen a rheumatologist? Typical symptoms of AS would be lower back pain, morning stiffness, pain with inactivity that improves with movement etc.

The SI joints, hips and spine are commonly involved, but really any joint can be involved.

An x-ray of the SI joints or an MRI is typically used to make the diagnosis. Sometimes blood work helps - they test for a certain gene -- HLA B27 and inflammatory markers (which may or may not be raised with AS).

CCFA has some good info about the various kinds of arthritis associated with Crohn's: http://www.ccfa.org/assets/pdfs/arthritiscomplications.pdf

Spondylitis.org also has some good info.

 

[jimmyt1989]

Thanks so much for the replies Clash and Maya142!

I did see a Rheumatolgist a few years back for a different issue. I was having some pain at the tendon insertion points. She tested me for the HLA-B27 marker, but it was negative. Numerous other arthritis markers were negative as well. I think that's why she checked the HLA-B27 marker, since Ankylosing Spondylitis is seronegative for most of the arthritis panels.

Thanks so much for sharing about your family members. I hope their treatment is effective.

Also, thanks so much for the links above!

All the best,

Jimmy

 

[my little penguin]

Ds was dx offically with juvenile spondyloarthritis about a year or two after his crohns dx
His joint pains started before
He is hla b27 positive
DH is dx with undifferentiated spondyloarthritis
He does not have Ibd and is hla b27 negative

I would suggest a revisit to a Rheumo
Good luck

 

[Maya142]

You can have spondyloarthritis without being HLA B27+. With AS specifically, 90% are HLA B27+ (in caucasians) but in axial spondyloarthritis and juvenile spondyloarthritis, that percentage is lower.

I agree, seeing another rheumatologist is a good idea. Typically, a pelvic MRI will be done look for inflammation in your SI joints if your x-rays are negative.

Good luck!

 

[ellie]

I had spondylitis pain about 5 years before there was any hint of CD. HLA negative, also RF negative(although with an aunt with bad rheumatoid arthritis)
Even now, my extra intestinal manifestations predominate - gut is officially in remission


HD

 

[tots]

I was told that it's very hard it on X-ray or ct scans. Is that true?
I have had all the symptoms had a bone density test and it showed changes
But not enough to dx anything


Lauren

 

[Maya142]

Sacroiliitis that is visible on an x-ray is needed to diagnosed AS. However, it can take up to 8-10 years for it to show up on an x-ray, which is why MRIs are now used for earlier dx.

If a pelvic MRI is positive for inflammation, then you would be given an Spondyloarthritis (SpA) diagnosis, which just means you don't yet have the damage required to diagnose AS. Some people never progress to AS with treatment, others do over time.

Typically, CT scans aren't used because of the radiation, but they could be used.

Inflammation does show up immediately on an MRI - it's just damage that takes time. If you're not HLA B27+, then you would technically need sacroiliitis on some kind of imaging to be officially diagnosed.

 

[Maya142]

Here are the criteria - you would either need to be HLA B27+ and have TWO SpA features (such as Crohn's/colitis, family history, good response to NSAIDs etc.) OR you would need to have a positive MRI/x-ray and one SpA feature.

New ASAS Classification Criteria
There are two sets, or arms, of the ASAS criteria: the imaging arm and the clinical arm.5 Each set is applied to patients with chronic (more than three months) back pain, the onset of which occurs at less than 45 years of age.

The imaging arm requires only one clinical parameter plus sacroiliitis (X-rays or MRI):

The sacroiliitis should show definite radiographic disease at grade 2 bilateral or grade 3 to 4 unilateral (according to modified NY criteria 1984); or
There should be active (acute) inflammation of sacroiliac joints on MRI, highly suggestive of sacroilliitis associated with SpA.

The clinical arm requires a positive HLA-B27 test plus two other clinical parameters, such as:

IBP;
Arthritis;
Enthesitis;
Uveitis;
Psoriasis;
Crohn’s disease/ulcerative colitis;
Good response to NSAIDs;
Family history of SpA;
Elevated C-reactive protein; and
Presence of HLA-B27.

 

[jimmyt1989]

Wow, thx so much for the info all!

I'll check back once I've seen the rheumatologist.

All the best.

 

[MizzSarah]

7 years prior to my diagnosis with Crohn's I suffered with severe joint related pains. Inflammation in my joints etc. I was diagnosed with idiopathic pain syndrome because none of the specialist I saw(including rheumatologist) could pin point what was happening. This was before the onset of abdominal pains...

I truly believe had I known Crohn's can mimick arthritic symptoms I would have been diagnosed much earlier.


All the best